Distinctive Clinico-electrographic and Radiological Profile of Childhood and Adolescent Seizures

AIM

Electroencephalogram (EEG) is specific, but not sensitive, for the diagnosis of epilepsy. This study aimed to correlate the clinico-electrographic and radiological features of seizure disorders in children attending a tertiary care centre in northern India.

METHODS

Children aged between one to 18 years with seizure episodes were included. Clinical details, including historical as well as physical findings, were evaluated along with EEG and neuroimaging (Magnetic resonance imaging). Details were noted on pre-designed proforma. Variables were analysed by using appropriate statistical methods.

RESULTS

A total of 110 children with seizures were enrolled in the study. Male to female ratio was 1.6: 1, and the mean age of the study children was 8 years. The majority of the children were symptomatic for more than one year. The most common seizure type was Generalised Tonic Clonic Seizure (GTCS), and Hypoxic-ischemic Encephalopathy (HIE) sequelae was the most commonly attributed etiology, followed by neurocysticercosis. EEG and neuroimaging findings were found to correlate well with seizure semiology from history. The incidence of febrile seizures was 10% in this study, with nearly three-fourths of them being simple febrile seizures.

CONCLUSION

Microcephaly and developmental delay were the most distinctive clinical correlates in children with seizures. There was a fair agreement between the types of seizures described in history and depicted on EEG with Cohen's kappa of 0.4. Also, there was a significant association between the type of seizures on EEG and the duration of symptoms.

Acute Exposure to Bisphenol S Decreases In Vitro Right Atrial Contractility in Rats

AIM/OBJECTIVE

Bisphenols are widely used in the manufacturing of polycarbonate material and epoxy resins which constitute the essential component of plastic. Bisphenol A (BPA) has been reported to produce toxicity on organs in both animal and human studies. Therefore, plastic manufacturers are replacing BPA with other analogues that are considered to be safe, and BPA-free products are now available in the market. However, some studies have reported that bisphenol-S (BPS) also possesses toxic properties. It has been reported to depress ventricular contraction as well as produce ventricular arrhythmia on acute exposure. The present study was performed to examine the effect of BPS on in vitro spontaneously-beating right atria in rats.

METHODS

In the present study, in vitro spontaneous contractions of right atria obtained from adult female rats of the Wistar strain were recorded. The atria were exposed to BPS (10-6-10 mM) and its effects on atrial contractions were recorded in the form of cumulative-concentration response with and without administration of antagonists namely atropine, L-NAME, and methylene blue.

RESULTS

BPS decreased the rate as well as the force of atrial contractions. The changes produced in the rate and force of atrial contractions were not attributed to ethanol, which was used to prepare BPS solutions. The decrease in right atrial contractility produced by BPS was blocked by L-NAME; however, atropine and methylene blue were not able to antagonize the effects of BPS on atria.

CONCLUSIONS

The present study indicates the involvement of NO-dependent but cGMP independent pathway responsible for BPS-induced cardio-toxicity.

Assessment of Visual Evoked Potential to Detect Visual Pathway Dysfunction in Gestational Diabetes Mellitus: A Longitudinal Case-Control Study With Postpartum Follow-up

BACKGROUND

The increasing prevalence of gestational diabetes mellitus (GDM) during pregnancy has opened the opportunity to study its short- and long-term effects on maternal ophthalmic health. Visual evoked potential (VEP) is a non-invasive electrophysiological test that detects functional disturbances along the visual pathway before the physical signs of diabetic retinopathy (DR) can set in. This longitudinal study is aimed at the assessment of changes in VEP in GDM during different stages of pregnancy and 6-12 weeks after parturition by comparing it with normoglycemic controls.

DESIGN AND METHOD

Diagnosed cases of GDM were recruited along with normoglycemic controls at 24-28 weeks of gestation. Each participant was required to attend two follow-up appointments at 32-38 weeks of gestation and 6-12 weeks after parturition. A blood sample was taken in a fasting state to record biochemical parameters. VEP was recorded using Neuropack S1 MEB-9400 electrodiagnostic equipment (Nihon Kohden, Tokyo, Japan) in a dark room by providing pattern reversal stimuli to each eye.

RESULTS

A total of 29 participants (15 in the control group and 14 in the GDM group) completed the entire study procedure. The observed mean P100 latency of both eyes in the GDM group was recorded longer as compared to that in the control group at baseline and during late pregnancy. Although the mean P100 latency saw a significant decline in postpartum visits as compared to that in late pregnancy, the values were higher than in the control group. P100 latency at baseline correlated significantly to serum advanced glycated end products' (AGE'S) levels in the GDM group.

CONCLUSION

Our study findings reflect that the diagnosis of GDM is associated with significant changes in VEP during and after pregnancy as compared to that of healthy pregnant women.

Evaluation of the Diurnal Cycle of Blood Pressure and Sleep in Shift Workers

BACKGROUND

Circadian misalignment of physiological factors in shift workers is poorly studied in the Indian population. In the present study, 24-hour blood pressure measurements were taken on the same subject twice, once during his morning and night shifts. Sleep was also monitored by a self-reported sleep diary, which was confirmed with an activity monitor, and the sleep quality was assessed using sleep questionnaires.

OBJECTIVE

This study aimed to discover the pattern of blood pressure variation, the dipping and non-dipping status, and its correlation with sleep.

METHODOLOGY

This observational study was conducted in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, from April 2019 to September 2019, among security guards working rotating shifts in the Rishikesh hospital premises. Participants were given an activity sheet with instructions to document their daily activities for a complete 24-hour period on the designated measurement day, including recording the time of waking up and going to sleep. A wrist-worn activity monitor was utilised to assess the self-reported sleep duration provided by each participant on the activity sheet.

RESULTS

The present study showed the mean age of the participants as 27.03 ± 2.71 years, along with a mean body mass index (BMI) of 22.10 ± 1.64. Sleep duration was significantly higher during the morning shift (5.81 ± 1.08 hours) compared to the night shift (4.02 ± 1.70 hours) on the day of ambulatory blood pressure monitoring (ABPM) recording. The mean difference in systolic blood pressure between night shift workers between their awake and sleep periods was 15.91 ± 8.44 mmHg. However, no statistically significant disparity was seen when comparing the systolic blood pressure at the 24-hour mark during wakefulness and sleep between those working morning and night shifts (p >0.05).

CONCLUSION

The current study's findings indicate that participation in shift work, particularly night shift work, could potentially play a role in the emergence of irregular circadian blood pressure patterns and potentially lead to a lack of nocturnal blood pressure decline.

Stroke Characteristics as Predictors of New-onset Seizure in Patients with Acute Ischemic Stroke

INTRODUCTION

The current guidelines on diagnosis and management of new-onset seizures in stroke are not well defined, especially in the Indian setting. Our study aims at providing insight into the hospital prevalence risk of new-onset seizures following ischemic stroke and to correlate seizure risk with the characteristics of stroke and other clinical parameters.

METHODS

A total of 127 patients were analyzed for the study where we assessed the clinical severity and the imaging severity of stroke using the National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT (ASPECT) score, respectively. Seizure-related variables including semiology, timing, and details of antiepileptic drugs (AEDs) were assessed under the domain of early and late poststroke seizures (PSSs). All patients were followed for 6 months for the seizure recurrence and change in Barthel index. In statistical analysis, quantitative variables were compared using the independent t-test/Mann-Whitney U test, and qualitative variables were correlated using Chi-square test/Fisher's exact test. Univariate and multivariate logistic regression was used to find out the significant risk factors of acute symptomatic seizure.

RESULTS

The mean age of the study population was 59.72 years (±14.77), with a male predominance (60.63%). About 78.74% of the cases had an NIHSS score more than or equal to 6.24% had posterior circulation strokes and the rest had anterior circulation strokes. A cortical location of infarct was observed in 62.2% of cases and a subcortical location in 61.4% of cases. The prevalence of early PSSs observed in our study was 10.6%. Of those, 80% had generalized seizures, 13.3% had focal seizures, and 6.67% had focal seizures with secondary generalizations. No patient in the study group had late-onset seizures. Total leukocyte count, serum protein levels, serum uric acid levels, and erythrocyte sedimentation rate (ESR) values were associated with early seizures (p<0.05). Patients with early seizures were found to have a longer hospital stay (8 vs 6 days with p<0.05). In the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) etiological classification, an acute stroke of undetermined etiology was found to have a significant association with the occurrence of early seizure in both univariate and multivariate analysis [p = 0.030; odds ratio (OR) 4.735 (1.160-22.576)]. There was no difference in change in the Barthel index among the two groups.

CONCLUSION

There was no recurrence of seizures in those who defaulted for AED and one patient had a seizure even on AED. Prophylactic AEDs in stroke patients based on stroke characteristics could not be ascertained, but the sample size was small. Knowing the fact that antiepileptics cause sedation and increase the chance of aspiration, continuing AEDs in patients who develop acute symptomatic seizures should be judged judiciously.

Maternal Chromium Levels in Gestational Diabetes: Systematic Review and Meta-Analysis

The topic of maternal Chromium (Cr) levels in Gestational Diabetes Mellitus (GDM) has remained controversial; some studies have found lower levels of Cr in GDM population, whereas others found no significant changes in Cr status in GDM. Therefore, this systematic review and meta-analysis was aimed at qualitatively and quantitatively synthesizing past studies to find the relationship of maternal Cr levels with GDM. The study protocol was registered at International prospective register for systematic reviews (PROSPERO) (ID CRD42021272979). Strict adherence to the Preferred Reporting Items for Systematic review and Meta-analysis checklist, 2009 was followed during the entire study. Random-effect model for calculation of distribution of true effect sizes was used for the meta-analysis with a confidence interval (CI) of 95%. The pooled Standard Mean Difference of control and GDM groups were compared using Z statistics with a P value of <.05 as significant. Six studies were included for the systematic review and four studies entered meta-analysis. The test of overall effect revealed that the pooled Cr values did not differ significantly between controls and GDM group (Z = 1.52, P =0.13). Heterogeneity between the studies was high (I2 = 97%). A subgroup analysis revealed that results varied as per place of study, trimester of pregnancy, and Cr estimation technique. Results from meta regression analysis revealed that sample size of individual studies (Q = 0.003, P =0.67) and year of publication of studies (Q = 0.22, P =.48) had no significant effect on the overall Standard Mean Difference. Factors such as ethnicity, lack of history of infection, and diet history can influence the results of this study.

Cardiovascular Autonomic Function Tests in Patients of Obsessive-Compulsive Disorder: A Cross-Sectional Study

BACKGROUND

Patients with psychiatric disorders are at an increased risk of developing cardiovascular disease, reducing life expectancy. Autonomic dysfunction has been linked to this increased risk; many studies have found reductions in heart rate variability (HRV). Only a few studies have systematically explored the relationship between obsessive-compulsive disorder (OCD) and autonomic function, and they have found contradicting results. The present study is intended to explore comprehensive autonomic functions in OCD patients and compare them with healthy controls.

METHODS

A total of 18 OCD patients meeting Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) criteria were enrolled to undergo comprehensive autonomic function testing, and the results were compared with 25 age- and sex-matched healthy controls.

RESULTS

Time-domain parameters of HRV such as standard deviation of the RR intervals, coefficient of variance of RR intervals, standard deviation of differences between adjacent RR intervals, root square of the mean of the sum of the squares of differences between adjacent RR intervals, and percentage of number of RR interval differences ≥ 50 ms were significantly lower in OCD patients, indicating lesser parasympathetic tone. Frequency-domain parameters such as total power and very low frequency were significantly lower in OCD patients, indicating a significant decrease in autonomic tone. Nonlinear parameters such as dispersion of points perpendicular to the line of identity and dispersion of points along the line of identity were significantly lower in OCD patients, indicating altered vagal and sympathetic tone. In autonomic reactivity tests, the fall in systolic blood pressure during the lying to standing test and change in diastolic blood pressure during the cold pressor test were significantly altered in OCD patients, indicating abnormal sympathetic reactivity. There was no significant correlation between autonomic parameters and the severity of OCD.

CONCLUSION

OCD is characterized by a decreased parasympathetic tone and abnormal sympathetic reactivity compared to normal controls.

Electrochemical fabrication of TiO2 micro-flowers for an efficient intracellular delivery using nanosecond light pulse

Introduction of foreign cargo into the targeted living cell with high transfection efficiency and high cell viability is an important mean for many biological and biomedical research purpose. Here, we have demonstrated a newly developed Titanium oxide micro-flower structure (TMS) for intracellular delivery. The TMS were formed on titanium (Ti) substrate using an electrochemical anodization process. The TMS consists of branches of titanium dioxide (TiO2) nanotubes, which play an important role in efficient cargo delivery. Due to nanosecond pulse laser exposure, Ti substrate heat-up, generating cavitation bubbles. These bubbles can rapidly grow, coalesce, and collapse to induce explosion resulting in very strong fluid flow through the TiO2 nanotubes and disrupt the cell plasma membrane promoting the delivery of biomolecules into cells. Using this platform, we successfully deliver dyes with 93% efficiency and nearly 98% cell viability into HCT cells, and this technique is potentially applicable for cellular therapy and diagnostics.

Expectations of healthcare personnel from infection prevention and control services for preparedness of healthcare organisation in view of COVID-19 pandemic

BACKGROUND

During infectious outbreaks like COVID-19, it is essential that every healthcare personnel (HCP) strictly adheres to infection prevention and control (IPC) policies. To boost IPC measures, training to reinforce preventive practices, which are pertinent to needs and encompass the expectations of the HCP, is indispensable. Thus, these expectations of the HCP should be explored.

METHODS

In this cross-sectional descriptive survey, we used convenience sampling technique to ask the participants to list their expectations on of covid-19 IPC training paper based forms. Using the category construction approach, we organised the expectations and grouped the participants on the basis of their work and place of work to analyse the association using the chi-square test.

RESULTS

Many participants expected to learn about the use of PPE and masks, hand hygiene, physical distancing, cleaning and disinfection, basic precautions for personal protection during the training. Expectations also included various administrative queries, sample collection and clinical skills for diagnosis and management. There was significant association of many categories of expectations with the nature and place of work in the hospital.

CONCLUSION

When planning IPC training, these expectations of the HCP may be carefully addressed. Information about causative agent, transmission and clinical aspects may will give a contextual meaning to IPC training. Some important preventive measures, which few participants expected to learn must be analysed in detail to understand the attitude of the HCP towards them. Efforts to appraise the HCP for the importance of these measures and promoting its practice may play a vital role to curb the spread of infectious diseases.

COVID-19 Prevention Protocol for an Organised Mass Gathering-An Essential Requisite in Pandemic and Post-Pandemic Phase

Coronavirus Disease 2019 (COVID-19) pandemic has stirred up chaos in the whole world. After prolonged lockdowns, finally, society is opening again for business and day-to-day life. Mass gatherings are undoubtedly again expected to start, but carry additional risks for transmission of the virus. We designed a concept model that was validated in about 1000 people gathering in a convocation ceremony at the beginning of the COVID-19 outbreak. A protocol was made, a risk assessment was done, and attendees followed-up. The emphasis on thermal screening, hand hygiene, physical distancing, open-air ventilation, refusing attendees having Influenza-Like Illnesses (ILI), and other preventive measures were the means to contain the potential transmission in an organised mass gathering of this magnitude. The dictum “prevention is better than cure” held amidst this outbreak. As a result of this well-structured mass gathering, the event was quite successfully conducted. Further event planning in the COVID-19 scenario or other outbreaks of similar infections must be managed in this way for the prevention of spread.

Fabrication of TiO2 microspikes for highly efficient intracellular delivery by pulse laser-assisted photoporation

The introduction of foreign cargo into living cells with high delivery efficiency and cell viability is a challenge in cell biology and biomedical research. Here, we demonstrate a nanosecond pulse laser-activated photoporation for highly efficient intracellular delivery using titanium dioxide (TiO₂) microspikes as a substratum. The TiO₂ microspikes were formed on titanium (Ti) substrate using an electrochemical anodization process. Cells were cultured on top of the TiO₂ microspikes as a monolayer, and the biomolecule was added. Due to pulse laser exposure of the TiO₂ microspike–cell membrane interface, the microspikes heat up and induce cavitation bubbles, which rapidly grow, coalesce and collapse to induce explosion, resulting in very strong fluid flow at the cell membrane surface. Thus, the cell plasma membrane disrupts and creates transient nanopores, allowing delivery of biomolecules into cells by a simple diffusion process. By this technique, we successfully delivered propidium iodide (PI) dye in HeLa cells with high delivery efficiency (93%) and high cell viability (98%) using 7 mJ pulse energy at 650 nm wavelength. Thus, our TiO₂ microspike-based platform is compact, easy to use, and potentially applicable for therapeutic and diagnostic purposes.

The introduction of foreign cargo into living cells with high delivery efficiency and cell viability by laser asisted photoporation on TiO₂ microspikes platform.

Formation of nanostructures on magnesium alloy by anodization for potential biomedical applications

In the present work, we have investigated the formation of nanostructures on AZ31 magnesium alloy using electrochemical anodization technique. The formed nanostructures were efficiently showed bone-like apatite formation followed by its gradual increase, when immersed in simulated body fluid (SBF) and it exhibited controlled degradation in 7 days. Cell viability study was performed using MG-63 cells (human osteosarcoma cell lines) and revealed that the nanostructured surface has excellent biocompatibility by enhancing both cell adhesion and cell growth. The detailed characterization of this anodized surface was evaluated by field emission scanning electron microscopy (FESEM) and energy-dispersive X-ray spectroscopy (EDS). Furthermore, surface-corrosion before and after anodization was examined by electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization studies in SBF. The in-depth studies bring out the fact that native oxide in the sample is converted to a biocompatible nanostructure, which is created due to anodization in a particular electrolyte solution containing ethylene glycol and hybrid hydrofluoric acid mixture.

Avian gut experiments: an alternative approach for teaching the properties of intestinal smooth muscles

Experiments on isolated mammalian gut are essential components of the physiology curriculum worldwide. Over the years, these routine experiments have been largely replaced by simulation modules, to reduce the euthanization of animals for understanding established facts and mechanisms in gut physiology. However, a medical undergraduate needs hands-on training to handle a living tissue to have a better understanding of physiology. The present sourcebook update describes the use of avian gut, which is usually discarded in abattoirs, as an effective replacement of mammalian gut to understand basic gut smooth muscle physiology. The avian gut can be used to study the effect of various drugs and ions as used in mammalian gut experiments. The experiment protocol described in the update can be performed by students of basic sciences and medical students using minimal laboratory set up and at low cost, producing results comparable to mammalian gut experiments. Ethical permissions may not be necessary; however, the disposal of tissue waste has to follow proper guidelines.

Scientific literacy and the medical student: A cross-sectional study

BACKGROUND

Problem-solving, critical thinking, communication skills and the ability to interpret data are four core components of scientific literacy, which any student must acquire during the educational process. This is of specific relevance to the medical profession as doctors need to be 'scientific' in their approach. The nine domains of scientific literacy are further grouped under two major abilities: understanding methods of enquiry that lead to scientific knowledge and the ability to organize, analyse and interpret quantitative data and scientific information.

METHODS

We included all first-year medical students within the first 2 months of admission in four medical colleges of India. We used the Test of Scientific Literacy Skills, a self- administered questionnaire, which is a validated and standardized tool for evaluating scientific literacy among students.

RESULTS

A total of 525 medical students participated in our study over 3 years-335 were males and the majority of students (73.5%) had joined medical college from schools affiliated with the Central Board of School Education system. The presence of scientific literacy skills across the study sample was low.

CONCLUSION

The relative lack of scientific literacy uncovered by our study needs to be addressed by medical colleges, using innovative student-centred approaches and incorporating social media literacy. Reforms are urgently required in the school education system, which serves as a feeder to the medical education system.

Ventilatory parameters at rest after months of stay at 3300 m: A comparison between acclimatized lowlanders and natives at Leh

Background

Increased pulmonary ventilation helps lowlanders and natives to maintain arterial oxygenation at high altitudes. Natives of Ladakh have been shown to have similar ventilatory parameters as Tibetans at 3300 m. But there is limited literature comparing these parameters in Ladakhi natives with acclimatized lowland sojourners.

Methods

End-tidal carbon dioxide partial pressure (EtCO₂), blood oxygen saturation (SpO₂) and hemoglobin concentration (Hb) were measured in 276 participants, 126 native highlanders (NHL - 40 females, 86 males) and 150 acclimatized lowlanders (ALL - 60 females, 90 males).

Results

EtCO₂ was greater in the NHL compared to the ALL, (33.8 ± 3.3 vs 31 ± 2.5 mmHg) although SpO₂ was lower (90.9 ± 2.4 vs 91.7 ± 2.3%). When grouped by sex, NHL males had significantly greater EtCO₂ than NHL females, ALL males and ALL females. Hb and calculated arterial oxygen content was similar in Ladakhis and acclimatized lowlanders, although greater in males compared to females. Systemic blood pressure, heart rate and the proportion of hypertensives was significantly greater in the ALL.

Conclusion

Native Ladakhis, have a significantly greater resting EtCO₂ (especially in males) and lower SpO₂ than acclimatized lowlanders. Blood Hb concentration and oxygen content is, however, similar in natives and acclimatized lowlanders of the same sex.

Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

Introduction

Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar.

Methods

Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs.

Results

The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved.

Conclusion

SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Association of Interictal Epileptiform Discharges with Sleep and Anti-Epileptic Drugs

BACKGROUND

The presence of interictal epileptiform discharges (IEDs) in electroencephalogram (EEG) is diagnostic of epilepsy. Latent IEDs are activated during sleep. Anti-epileptic drugs (AEDs) improve sleep. AEDs, sleep, and IEDs may interact and affect epilepsy management.

PURPOSE

To explore the occurrence of IEDs and its association with sleep and AED status in suspected patients of epilepsy.

METHODS

EEG records were collected of suspected patients of epilepsy who reported to the electrophysiology laboratory of a tertiary care hospital during 1 year. The anthropometric details, clinical presentations, and AED status of the patients were recorded from the EEG records. Patients were divided into 2 categories based on whether AEDs had been started prior to the EEG evaluation (category-I) or not (category-II). The occurrences of IEDs in EEG recordings in both categories were analyzed.

RESULTS

In 1 year, 138 patients were referred for diagnostic EEG evaluation. One-hundred-two patients fulfilled the inclusion criteria, of which 57 patients (53%) belonged to category-I and 45 patients (47%) belonged to category-II. Incidence of IEDs, suggestive of definite diagnosis of epilepsy in category-I was 88% and in category-II was 69%, and this difference was statistically significant (p = 0.02).

CONCLUSION

The increased proportion of IEDs in category-I patients may be due to high clinical suspicion or compounding interaction of AEDs and sleep. More extensive studies are required to delineate the complex interaction of AEDs, sleep, and IEDs so that judicious yet prompt management of epilepsy can be carried out.

Yoga Practice Improves Physiological and Biochemical Status at High Altitudes: A Prospective Case-control Study

Context • High altitude (HA) is a psychophysiological stressor for natives of lower altitudes. Reducing the morbidity and optimizing the performance of individuals deployed in an HA region has been attempted and reported with varied results. Objective • The present study intended to explore the effects of comprehensive yogic practices on the health and performance of Indian soldiers deployed at HAs. Design • The research team designed a prospective, randomized, case-control study.

SETTING

The study was done at Karu, Leh, India, at an altitude of 3445 m. Participants • Fully acclimatized soldiers in the Indian army were randomly selected from those posted to HA regions (ie, altitudes >3000 m). Intervention • The soldiers were divided into 2 groups of equal size. The first group, the control group, carried out the routine activities for physical training in the Indian army. The second group, the intervention group practiced a comprehensive yoga package, including physical asanas, pranayama, and meditation, and did not perform the physical training that the first group did. Both groups were monitored during their activities. Outcome Measures • A wide and comprehensive range of anthropometrical, physiological, biochemical, and psychological parameters were measured: (1) height and weight; (2) body fat percentage (BFP); (3) heart rate (HR); (4) respiratory rate (RR); (5) systolic and diastolic blood pressure (DPB); (6) peripheral saturation of oxygen; (7) end tidal CO2 (EtCO2); (8) chest expansion; (9) pulmonary function; (10) physical work capacity (VO2Max); (11) hematological variables; (12) lipid profile; (13) serum urea; (14) creatinine; (15) liver enzymes; (16) blood glucose; and (17) anxiety scores. Measurements were made at baseline and postintervention. Results • Two-hundred soldiers took part in the study. The yoga group showed a significant improvement in health indices and performance as compared with the control group. They had lower weights, BFPs, RRs, DBPs, and anxiety scores. They also had a significantly higher EtCO2, forced vital capacity, forced expiratory volume in the first second (FEV1), and VO2Max. Also, the yoga group showed a significant reduction in serum cholesterol, low-density lipoprotein, triglycerides, and blood urea as compared with their preyoga levels and with the exercise group. Conclusions • Practice of yoga facilitates improvements in health and performance at HAs and is superior to routine training with physical exercises. Comprehensive yogic practices are an effective modality for improving health and performance at HAs.

Effect of oxygen plasma immersion ion implantation on the formation of nanostructures over Ni–Ti alloy

Ni–Ti alloy has been implanted with oxygen ions by plasma immersion ion implantation. Ni–Ti–O nanotubes are formed by anodic oxidation of oxygen implanted Ni–Ti alloy.

Lower esophageal sphincter pressures in patients of bronchial asthma and its correlation with spirometric parameters: a case-control study

OBJECTIVES

The cause-effect relationship between bronchial asthma and gastro-esophageal reflux (GER) is known, but studies have not been able to confirm the improvement of lung function with anti-acid therapy. Hypotensive lower esophageal sphincter (LES) may lead to both acid and non-acid reflux, resulting in asthma symptoms and decreased lung function. The objectives of our study were, firstly, to compare basal LES pressure between adult patients of asthma and normal controls and, secondly, to correlate the basal LES pressure with spirometric parameters in these patients.

METHODS

Thirty patients, aged between 18 and 65 years, diagnosed as cases of bronchial asthma and 27 healthy controls were included in the study. All the participants were subjected to esophageal manometry after overnight fasting and basal LES pressures were recorded. Then, spirometry was done 2 h after meal and pre- and post-bronchodilator FEV1, FVC, PEFR were obtained for the asthma group.

RESULTS AND CONCLUSIONS

There is significant difference between basal LES pressure in patients of bronchial asthma and control population (8.70 ± 2.67 mmHg versus 16.64 ± 5.52, p < 0.0001). 66.67% of the asthma patients have reduced LES pressures (<10 mmHg). The correlation coefficient between basal LES pressure and prebronchodilator FEV1% predicted is 0.596 (p < 0.0001, 95% CI 0.3002-0.7872). Obstructive airway impairment in adult patients of bronchial asthma is associated with hypotensive LES. GER, due to hypotensive LES may contribute to deterioration of spirometric parameters in asthma patients.

Corrosion behaviour of tetrahedral amorphous carbon (ta-C) filled titania nano tubes

3D images of nanotube (a) TNT and ta-C filled TNT samples at (b) 0.5 min, (c) 1 min, (d) 2 min, (e) 5 min and (f) 10 min.

Effect of plasma nitriding on structure and biocompatibility of self-organised TiO2 nanotubes on Ti–6Al–7Nb

TiO₂ nanotubes formed by anodic oxidation of Ti–6Al–7Nb were nitrided in a nitrogen plasma.

Investigation of electrochemical behavior of nitrogen implanted Ti-15Mo-3Nb-3Al alloy in Hank's solution

Titanium alloy Ti-15-3-3 (Beta-21S) was implanted with nitrogen ions by plasma immersion ion implantation at 700, 750 and 800 °C. Micro Raman and XPS results confirm the formation of nitrides after implantation. Corrosion current density (icorr) of the treated samples in simulated body fluid (Hank's solution) is higher than that of the substrate. Treated samples also exhibit lower charge transfer resistance and higher double layer capacitance as compared to that of substrate in electrochemical impedance spectroscopic studies. However, no corrosion related effects are observed after 28 days of immersion in SBF. EDS results show the presence of oxygen after corrosion studies. XPS spectra from the implanted samples show the presence of nitride and oxynitride on the surface and formation of oxide due to corrosion process.

Gastrointestinal problems at high altitude

Gastrointestinal (GI) problems at high altitude are commonplace. The manifestations differ considerably in short-term visitors, long-term residents and native highlanders. Ethnic food habits and social norms also play a role in causing GI dysfuntion. Symptoms like nausea and vomiting are common manifestations of acute mountain sickness and are seen in 81.4% short-term visitors like mountaineers. Anorexia is almost universal and has a mutifactorial causation including effect of hormones like leptin and cholecystokinin and also due to hypoxia itself. Dyspepsia and flatulence are other common symptoms. Diarrhoea, often related to poor hygiene and sanitation is also frequently seen especially among the short-term visitors. Peptic ulceration and upper gastro-intestinal haemorrhage are reported to be common in native highlanders in the' Peruvian Andes (9.6/10000 population per year) and also from Ladakh in India. A hig h incidence o f gastriccarcinoma is also reported, especially from Bolivia (138.2 cases per 10000 population per year). Megacolon and sigmoid volvulus are common lower GI disorders at high altitude. The latter accounted for 79% of all intestinal obstructions at a Bolivian hospital. Thrombosis of the portosystemic vascultature and splenic hematomas has been reported from India. Malnutrition is multifactorial and mainly due to hypoxia. Fat malabsorption is probably significant only at altitudes > 5000m. Neonatal hyperbilirubinemia was found to be four times more common in babies born at high altitude in Colorado than at sea level. Gall stones disease is common in Peruvian highlands. A high seroprevalence of antibodies to H pylori (95%) has been found in Ladakh but its correlation to the prevalence of upper gastro-intestinal disease has not been proven.

Vasovagal syncope: an enigma

Syncope is a common clinical problem affecting 3.5% of the general population. About 40% of cases remain undiagnosed and 30% experience recurrent episodes. The article presents an update on the etiopathogenesis and theories of syncope. The pathophysiology of syncope remains elusive. Lewis introduced the term "vasovagal" implying therein that both vasodilatation and bradycardia were involved in the response. Individuals susceptible are unable to maintain adaptive neurocardiovascular responses to upright posture for prolonged periods of time. A complex hemodynamic response develops, with marked hypotension, bradycardia and a loss of consciousness. The "empty ventricle theory", first proposed by Sharpey - Schafer, widely accepted for several years, has been challenged and various other aspects of the vasovagal response have now been studied and implicated in contributing to the episode of unconsciousness. These include baroreflex dysfunction, neuro - endocrine responses, role of respiration and cerebrovascular dysfunction. An episode of syncope represents an episode of unconsciousness. Even a single episode of unconsciousness in the present day lifestyle is a source of distress to a patient, warranting a workup and diagnosis. The etiopathogenesis of the simple faint is complex and we may well be dealing with a constellation of responses and a more detailed classification than hitherto imagined.

Managing smarter: a decision support system for mental health providers

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers.

Peripheral nerve abscess in leprosy: report of twenty cases

During the year 1994-1995, 20 of the 67 leprosy patients attending the dermatology department with any kind of nerve involvement were found to be having nerve abscess. These abscesses occurred in all types of leprosy (except the Indeterminate) and a variety of nerve trunks and cutaneous nerves. In none of the instances the abscess was associated with reaction. All the patients were surgically treated, without any steroid therapy. All cases showed significant improvement whenever there was nerve function deficit. Similarly, pain was relieved in all cases, when it was present.

Keratoacanthoma centrifugum marginatum

A case of 38-year-old male with multiple keratoacanthoma centrifugum marginatum is reported. Clinical presentation was in the form of multiple, firm, non-tender skin coloured nodules of variable sizes. Diagnosis was confirmed by the histopathological examination. The case is being reported because it is a rare variant of keratoacanthoma.

Genetic nature of vitiligo

Four hundred vitiligo patients and 100 non-vitiliginous controls were studied to find out the prevalence of vitiligo in relatives of patients and controls. The difference was found to be statistically highly significant. The data reflected that there is some genetic mechanism involved in the etiology of vitiligo. Respective relatives of all forms of the disease in the vitiligo group showed a clear preponderance compared to controls. There was clustering of affected relatives in vitiligo cases compared to controls. The ratio of affected and unaffected siblings with unaffected parents or one parent affected, the ratio in the children of probands, the ratio in children of affected paternal and maternal grandparents of probands, suggest the polygenic nature of vitiligo.